To amend the Patient Protection and Affordable Care Act to identify individuals dually enrolled in Medicaid or CHIP and an Exchange.
Summary
H.R. 6516 aims to amend the Patient Protection and Affordable Care Act (ACA) by mandating the identification of individuals dually enrolled in both Medicaid or CHIP and a qualified health plan through an Exchange. This identification process would occur through the Public Assistance Reporting Information System (PARIS) on a recurring, at least quarterly, basis. The goal is to prevent individuals from improperly receiving premium tax credits or cost-sharing reductions under the ACA while also enrolled in Medicaid or CHIP.
Expected Effects
The bill's enactment would lead to a system where the Secretary is required to establish a program to cross-reference enrollment data between Exchanges and Medicaid/CHIP. This would likely result in some individuals losing premium tax credits or cost-sharing reductions if they are found to be dually enrolled. It could also lead to administrative changes for Exchanges and the Treasury Department.
Potential Benefits
- Reduced improper payments of premium tax credits and cost-sharing reductions.
- Improved efficiency in the allocation of healthcare resources.
- Potential savings for taxpayers by preventing duplicate benefits.
- Increased integrity of the ACA marketplace.
- Better data on dual enrollment patterns, which could inform future policy decisions.
Most Benefited Areas:
Potential Disadvantages
- Potential for errors in data matching, leading to incorrect termination of benefits.
- Increased administrative burden for state Medicaid/CHIP agencies and Exchanges.
- Possible confusion and hardship for individuals who are incorrectly identified as dually enrolled.
- May disproportionately affect low-income individuals who are eligible for both programs.
- Could create barriers to accessing healthcare for eligible individuals due to administrative complexities.
Constitutional Alignment
The bill appears to align with the General Welfare Clause of the Constitution, as it aims to ensure the efficient and proper use of taxpayer funds in healthcare programs. Specifically, the bill falls under Congress's power to regulate interstate commerce, as health insurance exchanges involve the buying and selling of health insurance across state lines. Article I, Section 8, Clause 3 grants Congress the power to regulate commerce among the several states.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).